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Significant R and D needed for measures addressed/linked to outcomes, are patient-centered and cover a broader array of conditions, settings, populations

Slide 19

Proposed Standard Specifications for Adherence Measurement

Numerator

New Users: For patients with no prescription in the 180 days prior to the measurement period, sum of:
Days' supply of all medications from the first prescription until the end of the measurement period.**Remove the days' supply that extend past the end of the measurement period.

Continuous users: For patients with 1 or more prescriptions in the 180 days prior to the measurement period, sum of:
Days' supply of all medications in the measurement period**Remove the days supply that extends past the end of the measurement period and add days supply from the previous period that apply to the current period.

Denominator

New Users: Number of days from the first prescription to the end of measurement period.

Continuous users: Number of days from the beginning to the end of the measurement period.

**Multiply by 100—cannot exceed 100%

Slide 20

Research Recommendations

Adherence Measures

Appropriate use/reasons for non-adherence

Plan of care measures

Expand patient/caregiver communication

Medication review/reconciliation

Content/accountability

COPD management

Lower risk patients

Outpatient psychiatry

Adherence/monitoring/polypharmacy

Migraine

Use of technology

Bar coding/decision support/dose calc.

Medication validation

Steps from order to patient/monitoring over time

Slide 21

Issues in Measuring Medication Management Quality

Measurement v. Improvement

Information lag/real time v. delayed

Use of measures—POC v. external

Accountability—pt/prescriber/pharmacist/plan

Patient-centered measures—$/values/preferences

Clinical exceptions v. "cookie cutter" medicine

Adequacy of data bases

Include Dx/Indication on Rx

Does measurement lead to improvement?

MH HEDIS

Does improvement lead to enhanced health status?

Diabetes and ACCORD

Slide 22

The State of Health Care Quality 2006, NCQA

There are, however, disturbing exceptions to this pattern of [overall health care quality] improvement. The quality of care for Americans with mental health problems remains as poor today as it was several years ago. Patients on antidepressant medication are about as likely to receive appropriate care today as they were in 1999.

http://www.ncqa.org

Slide 23

Image: A line graph of Optimal Practitioner Contacts Trends is shown. The Commercial line (red) is around 20% from 1998 to 2004. The Medicaid line (purple) is around 20% from 2001 to 2005. The Medicare line (green) is around 10% from 2001 to 2005.

Slide 24

Image: A graph of Effective Continuation Phase Treatment Trends is shown. The Commercial line (red) is around 40% and rises slightly from 1998 to 2005. The Medicaid line (purple) is around 40% and rises slightly from 2001 to 2005. The Medicare line (green) is around 30% from 2001 to 2005.

Slide 25

"Crossing the Quality Chasm"

Image: Silhoettes of three backpackers crossing a bridge with mountains behind them is shown.